Scalable Insurance Fraud Detection Solution

The Group Forensics Services (GFS) department, within a large insurance organisation, identifies and investigates transgressions within the broader company. Given the high volume and impact of their work, the department needed a scalable solution to improve their capturing and case management process.

Although simplistic in its concept, the GFS management process spans across several user roles with GFS users located across South Africa and Africa. As a result of this it wasn’t possible to have consistent interaction with all the users all of the time.

The management process, with its one-size- fits-all approach, was manual and outdated. The GFS department needed the new process to be customer-centric and measurable. Manual tasks needed to become automated through an easy-to- use web-based application. This solution would have to integrate with existing systems and also needed to be scalable.

The Solution

Saratoga was commissioned to replace the existing desktop application with a web-based solution, allowing the departments to more effectively capture, manage and report on their cases.

The Agile development methodology was followed for this project as it is conducive to consultation and change management. Using Agile allowed for the greater involvement of users and stakeholders throughout the development process.

• Saratoga implemented a web-based solution, using SharePoint technology to replace the previous desktop application.
• Given the confidential nature of the management process, it was vital that access to information is protected. The solution caters for this through the implementation of well-defined security features, e.g. user roles and audit trails.
• GFS is subject to regulatory compliance and as such, required a solution that supports and ensures data integrity.
• The solution had to be scalable and allow for ongoing implementation of new and enhanced features.
• Re-branding of the application was an integral part of the change management process.

The Results

The web-based solution provided by Saratoga for the GFS department greatly increased the efficiency of the management process and users are now able to better manage their cases.

• The new solution provides users with greater visibility into their various case allocations.
• Monitoring of cases in the management process and the overall user performance has improved.
• The scale-able solution provided users with a comprehensive case management process.
• Emphasis was placed on creating a solution that would provide improved user experience (UX).
• The implemented solution streamlined the operational processes of the various users.
• Security of information within the management process was enhanced by security features in the new solution.
• The re-branding involved all the local stakeholders, creating excitement within the team. The re-brand was widely celebrated within the organisation after implementation.